Reconciliation Program Manager

2 weeks ago

Somerville, Massachusetts, United States Mass General Brigham Full time
Job Title: Reconciliation Program Manager

Mass General Brigham Health Plan is a leading healthcare organization that is committed to providing innovative solutions to its members. As a Reconciliation Program Manager, you will play a critical role in ensuring that all enrollment reconciliation activities are functioning accurately to assist with overall member experience.

Key Responsibilities:
  • Ensure all 834 transactions are being correctly reconciled.
  • Work closely with IT to set requirements and user stories, as well as signing off on results and approving changes being promoted to production.
  • Lead teams to enable system automation in Enrollment to reduce administrative costs, improve member experience and operational efficiency.
  • Engage, empower and encourage staff; lead through change and adversity. Make decisions as needed and build consensus as appropriate.
  • Identify and create the processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
  • Focus on internal reconciliation portal accuracy (MERP tool), as well as QNXT specific troubleshooters.
  • Responsible for identifying and documenting process gaps and improvements.
  • Responsible for ensuring reconciliation tools are in place for all enrollment activities including EDI file load, processing pended/ rejected transactions, paper & online enrollments.
  • Responsible for managing all vendor extracts and error reports, documenting processes and ensuring issues identified by the team are communicated proactively.
  • Lead for all data requests in the Enrollment team including audit responses.
  • Resource and liaison to other departments, and external customers, in resolving account operational/transaction issues when applicable.
  • Develops and maintains specific processes in accordance with regulatory guidelines set forth by the DOI and Attorney General's Office (AGO).
  • Lead and drive corporate efforts to improve business processes and systems by collaborating with other departments.
  • Key eligibility contact person for the Behavioral Health, Dental, Eye Med, ID Card and Pharmacy vendors.
  • Work with IT to approve and prioritize tickets entered by team members.
  • Attend and participate on project teams to provide feedback on Enrollment processes when applicable.
  • Persist in accomplishing objectives, despite obstacles and setbacks to consistently achieve results.
  • Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships-both internal as well as external.
  • Hold self and others accountable to meet commitments.
  • Ensure diversity, equity, and inclusion are integrated as a guiding principle.
  • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
  • Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
  • Other duties as assigned with or without accommodation
Qualifications:
  • BA/BS degree required or the equivalent combination of training and experience, plus 5+ years of related experience.
  • 5+ years of reconciliation experience required.
  • 4+ years managing staff preferred and preferably within a managed care environment.
  • Experience in SQL server
  • Proficient with MS Office Suite, including Power BI, PowerPoint, Excel, and Word
  • Understanding of QNXT and 834 EDI transactions
  • Understanding of 820 transactions
  • Problem-solving, leadership and independent initiative
Customer Service capabilities:
  • Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
  • Bring fresh ideas forward by listening to and working with employees and the people we serve.
  • Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
  • Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
  • Strong aptitude for technology-based solutions.
  • Ability to inject energy, when and where it's needed.
  • Current in healthcare trends.
  • Demonstrated forward, visionary thinking; ability to see 'what is' and envision 'what could be.'
  • Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
  • Excellent leadership skills and leadership track record.
  • Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
  • Ability to view the long-range trends and cycles of the business and industry and see the 'big picture.'
  • Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
  • Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
  • Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
  • Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
  • Unquestionable integrity
Job Field:

Professional/Managerial

Organization:

Mass General Brigham Health Plan

Schedule:

Full-time

Shift:

Day Job

Employee Status:

Regular

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